Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
0127 NHSC Community Site Information Form Removed 0 0 0 Form 0127-2
0127 NHSC Loan Information and Verification Form Removed 0 0 0 Form 0127-3
Authorization for Disclosure of Loan Information Form New 150 15 0 Form and Instruction 3
NHSC Alumni Database Removed 0 0 0 Form 0127-5
NHSC Self-Certification Form Removed 0 0 0 Form 0127-6
Privacy Act Release Authorization Form Modified 100 10 0 Form and Instruction 2
Private Practice Option Form New 300 30 0 Form and Instruction 4
The National Health Service Corps (NHSC) Loan Repayment Program Application Modified 8200 8200 0 Form and Instruction 1
Verification of Disadvantaged Background Form New 600 300 0 Form and Instruction 5
Total burden requested under this ICR: 9350 8555 0  
To view an IC, click on IC Title